Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients.

Autor: Lohman MC; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. lohmanm@mailbox.sc.edu.; Dartmouth Centers for Health and Aging, Lebanon, NH, USA. lohmanm@mailbox.sc.edu., Cotton BP; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.; Dartmouth Centers for Health and Aging, Lebanon, NH, USA., Zagaria AB; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA., Bao Y; Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.; Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA., Greenberg RL; Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY, USA., Fortuna KL; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.; Dartmouth Centers for Health and Aging, Lebanon, NH, USA., Bruce ML; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.; Dartmouth Centers for Health and Aging, Lebanon, NH, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2017 Dec; Vol. 32 (12), pp. 1301-1308. Date of Electronic Publication: 2017 Aug 28.
DOI: 10.1007/s11606-017-4157-0
Abstrakt: Background: Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population.
Objective: To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients.
Design: Cross-sectional analysis using data from 132 home health agencies in the US.
Subjects: Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780).
Main Measures: Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use.
Key Results: In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital.
Conclusions: Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes, hospitalizations, and care transitions are justified.
Databáze: MEDLINE
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